Incorporating residual kidney function into the dosing of intermittent hemodialysis
- Anthony Bleyer, MD, MS
Anthony Bleyer, MD, MS
- Professor of Internal Medicine/Nephrology
- Wake Forest University School of Medicine
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
Most incident end-stage renal disease (ESRD) patients have some level of native renal function remaining when they initiate hemodialysis. For selected patients who have significant residual kidney function, some expert clinicians advocate that, under certain circumstances, the hemodialysis dose can be adjusted for the clearance provided by native kidney function. In such patients, the target clearance (ie, Kt/V) is the sum of clearances provided by hemodialysis and native kidney function [1-3]. As a result, the hemodialysis dose is lower than that which is typically prescribed. This method of prescribing a lower hemodialysis dose depending on the clearance provided by residual kidney function is called incremental hemodialysis .
The amount of prescribed hemodialysis can be decreased by reducing the hemodialysis time (for example, by time per session or by number of sessions) or by altering operating conditions such as dialyzer size and type, dialysate flow rate, or blood flow rate. The dose of hemodialysis must then be increased over time as residual kidney function declines in order to avoid uremia.
This topic review provides methods of providing incremental hemodialysis, including methods of estimating the hemodialysis dose based upon residual kidney function clearance.
Calculation of the standard hemodialysis dose is discussed elsewhere. (See "Prescribing and assessing adequate hemodialysis".)
Incremental peritoneal dialysis is discussed elsewhere. (See "Prescribing and assessing adequate peritoneal dialysis", section on 'Solute clearance'.)
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